Title

Author

Defense Date

2007

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Adult Health Nursing

First Advisor

Dr. Jean Salyer

Abstract

Although it is well known that self-care reduces the frequency of hospital admissions and exacerbations and enhances quality of life (QOL) in heart failure (HF) patients, little is known about self-care in this population. Therefore, the study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, comorbidities, and social support), self-care strategies, and QOL using Reigel's Model of Self Care in Patients with Heart Failure as the guiding framework. In this descriptive correlational study, self-care was measured using the Self-Care of Heart Failure Index (SCHFI), which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence (SC-Sc). QOL was measured using a disease-specific instrument, the Minnesota Living with Heart Failure Questionnaire (LHFQ), and a generic instrument, the Short-Form Health Survey (SF-12) characterizing physical and mental-emotional functioning. Multiple regression analysis was used to identify predictors of QOL.Data were collected using Dillman's tailored design method for surveys. One hundred and sixty-five patients with HF were invited through a mailed letter and a survey packet to participate in this study. Five potential participants requested not to take part in the study, seven were reported as being deceased, and 23 letters were returned as undeliverable. After the initial mailing, we discontinued mailings to them. Thus, out of a possible sample of 130 subjects, 98 participants completed and returned questionnaires for a response rate of 75.38%.The sample (mean age = 56.33 years, SD = 13.65) included 56.1% males and 43.9% females and consisted of 48% Caucasians and 52% non-Caucasians. Approximately 55.1% were married and 60.2% had an annual income less than $30,000. The majority of the sample (72.5%) had at least a high school education. Half of the sample were somewhat functionally impaired (NYHA Class 11) and had an ejection fraction less than 30%. Ninety-three percent of the sample had been diagnosed with HF less than 10 years (mean = 5.05, SD = 3.34). Seventy percent of the sample had 0 to 4 comorbidities, and 17.7% reported that they only had HF and no other diagnoses. In addition, the sample reported mean score of social support at 71.72 (SD = 17.30) indicating good social support. On average, participants reported that they frequently performed self-care in order to maintain a healthy lifestyle: SC-Mt (mean = 69.59, SD = 15.56). They responded quickly and were likely to manage signs and symptoms that occurred: SC-Mn (mean = 61.69, SD = 19.91). Sixty-two percent reported that they recognized signs and symptoms of HF that occurred in the last month. They were very confident they could perform self-care: SC-Sc (mean = 66.11, SD = 17.02). The results showed that the participants' perceived their QOL as good (mean = 49.44, SD = 27.82). On average, participants perceived their physical functioning as fair (mean = 45.38, SD = 22.47), as was their mental-emotional functioning (mean = 53.32, SD = 22.36).Multiple regression analyses demonstrated that better disease-specific QOL was predicted by being less likely to use SC-Mn strategies (β = .325; p = 0.003), better SC-Sc (β = -.251; p = 0.012), better NYHA functional class (β = .246; p = 0.008), and less comorbidity (β = .236; p = 0.014) (R 2 = .334; F = 7.269, p = 0.000). Better generic QOL (physical functioning) was predicted by better NYHA functional class (β = -.309; p = 0.001), better SC-Mt (β = .205; p = 0.037), better SC-Se (β = .296; p = 0.003), and being less likely to try SC-Mn strategies (β = -.165; p = 0.000) (R 2 = .361; F = 9.602, p = 0.000). Better generic QOL (mental-emotional functioning) was predicted by better NYHA functional class (β = -.229; p = 0.024) and being male (β = -.204; p = .047) (R 2 = .277; F = 4.548, p = 0.000).Findings suggest that better QOL is associated with being male displaying better NYHA functional class, less co-morbidity, and better performance of self-care activities in order to maintain health (SC-Mt), being less likely to identify and respond quickly to signs and symptoms of HF (SC-Mn), having and confidence in performing of self-care strategies (SC-Se). The findings add to the scientific body of knowledge in self-care.